UC Health Study Hopes To End Confusion Over Mammogram Screenings
February 20, 2018 1:36 p.m.
UC Health Study Hopes To End Confusion Over Mammogram Screenings
Lisa Madlensky, program director and genetic counselor, Moores Cancer Center at UC San Diego Health
The American Cancer Society guidelines on getting mammograms says that women should begin having yearly breast screening by 845 and contains to having mammograms beginning at age 55. Not everyone agrees with those guidelines. Women get a lot of conflicting advice even from health professionals on when to start and how often to have mammograms. Now we move across -- women across California are being asked to volunteer in the study that may help to end the confusion. It is called wisdom in being conducted by the UC health systems. Joining Ms. Lisa Meth Linsky program director and genetic counselor at Morris UC San Diego cancer center. She is also one of the researchers working on the sun that school study at UC San Diego. Tell us why this really large health study is needed? What is a level of confusion among women and even health professionals about breast screening?
>> One of the sources of confusion is with medical society guidelines. You just mentioned the American Cancer Society guidelines. There are other guidelines that say start when you are 40 and go every year. There are other guidelines that say wait until you are 50 and then go every other year. We really have multiple guidelines for multiple sources. Sometimes it is really difficult for a woman to just asked a simple question, when should I start and how often should I go for my mammograms.
>>> Are There'd down sides for standardized spirits cancer processes aside for the fact that they now tend to be confusing.
>> I think one of the issues is with any guideline that takes a one-size-fits-all approach will always be challenging. Some women are at very high risk of cancer. They may know that or may not know that. Other women may have a very low risk of breast cancer. They may not need as much screening. One of our goals is to say is there one perfect guideline for everybody but that doesn't really make sense. Does that make more sense to do a more personalized approach and give everyone one of three or four guidelines that makes the more sense for them.
>>> Talk about the wisdom study. How is it working, how is it work?
>> The wisdom study is unique. Most of the time when people think of a study, a lot of times, you join and you are randomized to group A or group B. And you do a head-to-head comparison of those two groups. That is also true for wisdom. One of the unique components is that women can join, they can be randomized, and we hope that most women will be agreeing to be randomized. But women who have a strong preference for group A or group B can actually choose which group they want to be in. So group A is what we call our annual mammogram. This is the one where women essentially just keep doing the regular breast screening. Participation involves signing up and agreeing to fill out a survey once per year. And allow us to review their mammogram records. Group he is the new approach. This is the personalized one. This one includes pretty much everything we know about breast cancer risk factors. It includes genetic testing for the BRCA1 and BRCA2 genes, as well as seven other genes that are related to a very high rate of breast cancer. Our approach with this study is to basically say is the personalized approach as safe as what we are already doing. The way we measure that is by looking at how many advanced cancers occur over the course of the study in each of the two groups. If the personalized approach is the same or better, than the current approach, that tells us the personalized approach is better. On the other hand, we don't know how this will pan out. It is a study. We don't know the answer yet. That is our hypothesis is that the personalized approach will actually lead to less breast screening but equal outcomes.
>>> How long will you track the participants in the wisdom study?
>> It started out as a five-year study as most research studies do. But there is always the possibility of extending it out. The longer we extended out, the more data we will be able to cure -- accrue. At this point in time it's a five-year study. Struck at the women who are very concerned about the possibly being high risk for rest cancer will probably want to sign up to be in that second group of women who will be personalizing their health statistics. Have you keep this fair so that it is not the second group is not completely weighted by people who may indeed be higher risk for cancer.
>> Correct. That is the one of the things we are tracking. Our primary goal is to say does the existing approach to screening work better frequently than our more innovative and personalized approach. The other thing that is important to track is what do women want to do in terms of their breast screening. If somebody has very strong feelings about I want to start at 40 and go every year, they can do that. As long as they are helping us by responding to the surveys and telling us when they are going, how often, and answering survey questions about their preferences. You are right. A lot of women who believe that they are high risk because of family history or other factors do have a tendency to select the personalized arm. On the other hand, we noticed that when women start reading about the benefits overall, not necessarily personally but to the bigger picture, what does this information mean for all women in the future, a lot of people will choose to be randomized. Whatever happens, happens. They get the arm that they are in. I am also participating as a participant. I elected to be randomized. Just because that that is the more balanced approach to getting the information. But this is what is called a pragmatic trial. That is why we actually allow people to self select if they have a strong preference one way or the other.
>>> The wisdom study aims to sign up 100,000 women. So far about 9500 Overall across the state, 3500 women in San Diego have signed up. What are the eligibility requirements? Where can they actually sign up for this wisdom study?
>>> The study website is wisdom study.org. There they can read all of the information about participating, sign up right then and there on the website. It is for women aged 40 to 74. The only exclusion we have is that you cannot have previously had a breast cancer diagnosis. Really, all women who are in our eligible screening poll for mammograms regularly, that is the study population that we are looking at.
>>> I have been speaking with Lisa Matt Linsky counselor at Morris UC San Diego cancer center. Lisa, thank you.
>> Thank you very much.